An evaluation of the drug calculation skills of registered nurses.

Mathematical skill and proficiency underpin a number of nursing activities, with the most common application being in relation to drug dosage calculation and administration. Medication errors have been identified as the most common type of error affecting patient safety and the most common single preventable cause of adverse events and they can occur as a result of mathematical calculation error and or conceptual error. The purpose of this study was to evaluate the drug calculation skills of registered nurses (n = 124) on commencement of employment. The findings of this study indicate that there are inconsistencies in the amount of pharmacology content and drug calculation skills delivered within nursing curricula. The most frequent type of drug calculation errors are attributed to conceptual errors and participants identified ward based education on drug calculation as a pathway for improving the drug calculation skills of registered nurses. The study recommends that medication education, encompassing mathematical and conceptual drug calculation skills should be identified as a distinct competency in nursing curricula and continuing education programme.

A literature review of the individual and systems factors that contribute to medication errors in nursing practice.

AIM: This paper reports a review of the empirical literature on factors that contribute to medication errors. BACKGROUND: Medication errors are a significant cause of morbidity and mortality in hospitalized patients. This creates an imperative to reduce medication errors to deliver safe and ethical care to patients. METHOD: The databases CINAHL, PubMed, Science Direct and Synergy were searched from 1988 to 2007 using the keywords medication errors, medication management, medication reconciliation, medication knowledge and mathematical skills, and reporting medication errors. RESULTS Contributory factors to nursing medication errors are manifold, and include both individual and systems issues. These include medication reconciliation, the types of drug distribution system, the quality of prescriptions, and deviation from procedures including distractions during administration, excessive workloads, and nurse's knowledge of medications. IMPLICATIONS FOR NURSING MANAGEMENT: It is imperative that managers implement strategies to reduce medication errors including the establishment of reporting mechanisms at international and national levels to include the evaluation and audit of practice at a local level. Systematic approaches to medication reconciliation can also reduce medication error significantly. Promoting consistency between health care professionals as to what constitutes medication error will contribute to increased accuracy and compliance in reporting of medication errors, thereby informing health care policies aimed at reducing the occurrence of medication errors. Acquisition and maintenance of mathematical competency for nurses in practice is an important issue in the prevention of medication error. The health care industry can benefit from learning from other high-risk industries such as aviation in the prevention and management of systems errors.

Adverse events in health care: a literature review.

AIM: This paper aims to develop understanding of the nature, costs and strategies to reduce or prevent a range of adverse events experienced by people within the health care system. BACKGROUND: Care interventions are not always based on safe practice and adverse events can and do occur that cause or place at risk patients lives and well-being. The nature of adverse events is diverse and can be attributed to a multitude of individual and system contributory factors and causes. EVALUATION: A review of the literature was undertaken in 2006 and 2007 using the following databases: Pubmed, CINAHL, Biomed Ovid, Synergy and the British Nursing Index. This paper evaluates the literature that pertains to adverse events and seeks understanding of this complex issue. KEY ISSUES: Published statistics confirm that globally, professional errors in clinical practice and care delivery occur at an unacceptably high level and result in considerable human and financial consequences. CONCLUSION: Reaching understanding of the multiple factors that contribute to unsafe clinical practice situations requires a cultural shift in organizations. IMPLICATION FOR NURSING MANAGEMENT: Reasons for adverse events are complex and require healthcare managers to evaluate the system issues which impact on the delivery and organization of care.